Midwives make a world of difference in Native American Communities: More satisfaction, fewer cesareans, more VBACs

Welcome to the first issue of the MANA E-Zine!

When the last paper issue of the MANA News was mailed last year, the MANA Board started working toward developing a system of eNewsletters to replace the printed issues. This decision was made given the costs - both in dollars and in natural resources - of printing and mailing the paper issues and the fact that over half of our members had said they would rather read the pdf version than have it mailed to them! Also, as the MANA On-line Community Managers communicate daily through Facebook, Twitter, Pinterest, and the MANA blog, much of the information previously given out in the printed newsletter is now shared on a more timely basis through social media.

On March 4 MANA released our first ever E-Zine in the new format which combines articles with links to the MANA website for further information!

Largest Ever U.S. Study On Planned Home Birth

Finds Low Rate of Interventions, No Increased Risk for Mother and Baby

In the largest ever examination of planned home births in the United States, a study released today by the Journal of Midwifery and Women’s Health found that, among low-risk women, planned home births result in low rates of birth interventions without an increase in adverse outcomes for mothers and newborns, and also result in significant health benefits for women and their infants. (Posted on Jan 30, 2014)

On Tuesday, January 21, the Coalition for Quality Maternity Care (CQMC), a group of which MANA is a partner organization and led by ACNM, submitted comments to the Centers for Medicare and Medicaid Services (CMS) in response to a Notice that the agency issued on November 19, 2013. In this Notice, CMS outlined quality measures that will be included within a developing Quality Rating System (QRS) to be used to rank health plans offered through the new Health Insurance Marketplaces.

The Affordable Care Act requires Marketplaces to provide consumers with tools for comparing plans to help them make informed decisions regarding which plans they wish to enroll under. In CMS’ Notice, they list 42 quality measures for use in the QRS. Only two of them dealt with maternity care. Maternity care is one of ten mandated benefit categories that must be covered by plans offered through the Marketplace (and many plans operating outside the Marketplace as well).

The CQMC recommended that CMS include several other quality metrics related to maternity care and suggested that the most important measures for use in the QRS with regard to maternity care included those related to the rate of cesarean sections, the rate of breastfeeding and the occurrence and timeliness of prenatal and postpartum care.

(Posted January 23, 2014. First posted by American College of Nurse-Midwives, Jan 22, 2014)

January 16, 2014 — A new California law (AB 1308) gives midwives more autonomy and lifts a requirement that a doctor be present during childbirth, KQED's "The California Report" reports. The law took effect Jan. 1.

The previous policy had been in place for two decades, but physicians were unwilling to supervise midwives because their malpractice insurance would not cover out-of-hospital births. Recognizing that it was impossible for midwives to comply, the California Medical Board suggested changing the law.

Details of Changes

In addition to lifting the supervision requirement, the new law allows midwives to accept coverage through the state's Medicaid program, which supporters said is an important step in giving low-income women a choice in the kind of care they receive.

The law also allows licensed midwives to order ultrasounds, prescription drugs and lab tests. However, the law specifies that midwives are prohibited from offering their services to women pregnant with twins or those with breech babies. It also states that midwives must send a woman to a doctor if there are any abnormalities with her pregnancy (Dembosky, "The California Report," KQED, 1/10).

Almost 4 million babies were born in the US in 2012, and more of them were born outside the hospital than have been since before 1989. Of the 50,000 births that occurred outside of a hospital, about two-thirds occurred in a home, and most of the rest occurred at a birthing center. The birth rate in women aged 15 to 19 also decreased by 6 percent in 2012.

Experts say that a history of depression can fuel the risk for postpartum depression. Now a new study finds that apprehensions of childbirth may also trigger feelings of postnatal depression in some women. Fear of childbirth tripled the threat of PPD in women who have never been treated for depression and increased the risk fivefold in those with the condition.

About one in every 33 babies is born with a birth defect. Join the Centers for Disease Control and Prevention's National Center on Birth Defects and Developmental Disabilities in National Birth Defects Prevention Month. Share infographicsand buttonson social media, and check the CDC home pageevery week for a new, special Web feature.

(Posted January 10, 2014)

Coalition for Quality Maternity Care (CQMC)

On Monday, January 6, the Coalition for Quality Maternity Care (CQMC), of which MANA is a member organization, submitted a letter to the Medicaid and CHIP Payment and Access Commission (MACPAC) providing specific recommendations regarding issues related to maternity care. MACPAC is a non-partisan, federal agency charged with providing policy and data analysis to the Congress on Medicaid and CHIP, and for making recommendations to the Congress and the Secretary of the U.S. Department of Health and Human Services, and the states on a wide range of issues affecting those programs. MACPAC responded to the CQMC letter, indicating that the recommendations had been circulated to commissioners and appropriate staff. The Commission has included a chapter providing general information on Medicaid’s maternity care in one of its previous reports and plans to include recommendations from previous reports maternity care in a forthcoming report, focused on the complexities around Medicaid coverage for pregnant women. The goal of the CQMC was to foster continued focus on maternity care by MACPAC as much of its previous work has centered on other aspects of coverage under Medicaid.

Midwives are primary providers of care for childbearing women around the world. However, there is a lack of synthesised information to establish whether there are differences in morbidity and mortality, effectiveness and psychosocial outcomes between midwife-led continuity models and other models of care. [Read More]

Money May Be Motivating Doctors To Do More C-Sections - September 2, 2013

Obstetricians perform more cesarean sections when there are financial incentives to do so, according to a new study that explores links between economic incentives and medical decision-making during childbirth. [Read More]

History and Future of the US MERA Joint Project

In the triennium between 2008--2011, the International Confederation of Midwives (ICM) took the Bold step of developing a group of essential documents that described the “Three Pillars” of midwifery, namely education, regulation and association, which were built upon the foundation of the ICM Essential Competencies for Basic Midwifery and the ICM Definition of a Midwife. The Three Pillars are meant to be interdependent and interrelated and embody ICM’s vision to strengthen mid--wifery worldwide in order to provide high--quality, evidence--based care for women, newborns, and childbearing families, and decrease maternal and infant mortality and morbidity. The documents together comprise the global standards for midwifery education, practice and regulation and are a complete package of information for midwives, policy makers, regulators and governments. [Read the Full Report Here]

Study Finds Adverse Effects of Pitocin in Newborns

New Orleans, LA -- Induction and augmentation of labor with the hormone oxytocin may not be as safe for full-term newborns as previously believed, according to research presented today at the Annual Clinical Meeting of The American College of Obstetricians and Gynecologists. Researchers say this is the first study of its kind to present data on the adverse effects of Pitocin use on newborns. [More]

A Home Birth Primer For MCH Programs

In light of the recent attention on safe birthing practices and the newly released AAP policy statement on Planned Home Births, the Association of Maternal & Child Health Programs will host the national webinar, "A Home Birth Primer for MCH Programs,"on Thursday, July 11, 2013, 2:00-3:30 pm Eastern. This 90 minute webinar will be moderated by Valerie Ricker, RN, MSN, MS, Title V Director for the Maine Center for Disease Control and Prevention, and will feature the following presenters:

Increase knowledge of the effects of maternal and infant care services in this type of birth setting

Summarize the 2011 ACOG and 2013 AAP statements on planned home birth

Describe the practical implications of the statements for MCH programs

This webinar is part of the AMCHP Women's Health Information Series, a webinar series supported by the Centers for Disease Control and Prevention's Division of Reproductive Health. [More]

Transforming the Costly Travesty of US Maternity Care

What's the most common reason for hospitalization—and the most costly? It's maternal and newborn care.

Despite some progress in maternal-newborn care, such as a decrease in the rate of premature birth, the United States continues to perform poorly on some important quality and cost indicators. Cesarean delivery is now the most common operating room procedure in the United States. The US rate of cesarean deliveries, an appalling 33%, increased 53% between 1997 and 2009. [More]

Ruling A Boon To Home Birth Advocates

A state Appellate Court ruling is being hailed as a victory for midwives and the right of Connecticut families to choose home births.

The court issued a decision in a case that pitted two midwives against the Connecticut Medical Examining Board. The ruling ended more than a decade of litigation in which the Department of Public Health had tried to outlaw home births by midwives who are neither doctors nor nurses, branding it as the "unauthorized practice of medicine," said attorney Diane Polan, of New Haven. [More]

Early Skin-to-Skin Contact for Mothers and their Healthy Newborns

In humans, routine mother-infant separation shortly after birth is unique to the 20th century. This practice diverges from evolutionary history, where neonatal survival depended on close and virtually continuous maternal contact. This presentation will report the results of a 2012 Cochrane Review of early skin-to-skin contact including thirty-four studies with 2177 mother-infant dyads. Implications for clinical practice will also be discussed. [More]

Cost of U.S. childbirth outrageous

(CNN) -- Across the U.S., many families know firsthand how high maternity care costs are. As noted in The Times recently, giving birth in the U.S. is more expensive than any other country in the world. Total costs average $18,329 for a vaginal delivery and $27,866 for a C-section, with the bulk of the bill going to insurers. However, families with insurance still have to pay about $3400 out of pocket.

Listening to Mothers III report released

Childbirth Connection's Listening to Mothers III report is the third in a series of landmark studies that poll American women about their maternity care experiences. The study summarizes results of a survey of 2,400 mothers who gave birth in hospitals in 2011 to 2012. Among the findings: risky procedures are overused, many beneficial practices are underused, and all too often women lack the support and knowledge required to effectively navigate their maternity care.

Ina May Gaskin featured on CBC News

A piece that ran on the Mother's Day episode of "Sunday Morning" on CBS highlights Ina May Gaskin, co-founder and past President of MANA, speaking about pertinent information about the modern midwifery community.

One more state legalizes CPMs

In April 2013, after years of pursuing a regulated status for direct-entry midwives, with the passage of HB1135 Indiana became the 28th state in the U.S. to provide a legal status for Certified Professional Midwives (CPM). There is still work ahead. Indiana's new law provides certification, rather than licensure. Some of the provisions are less than ideal, such as the requirement that midwives have an informal collaborative agreement with a physician and that mothers see a physician twice at prescribed times during her pregnancy. The Indiana strategy will require much more work as rules and regulations are written and more legislative work as midwives push for complete autonomy. Congratulations Indiana!

Save the Children releases annual State of the World's Mothers report and calls for more midwives

In commemoration of Mother's Day, Save the Children published its 14th annual State of the World's Mothersreport. The report reveals that the United States has the highest first-day infant death rate of all the industrialized countries in the world. One part of their strategy for healthier moms and babies worldwide: more midwives.

The World Alliance for Breastfeeding Action has released a Statement on Maternity Protection for International Labour Day, May 1, 2013, which calls for all countries to improve their legislation and ratify the most recent International Labour Organization convention on maternity protection as a step toward addressing the problems that working mothers must face during pregnancy, childbirth, and the postpartum period.

MANA joined dozens of other organizations in signing a letter of support to the sponsors of the Racial and Ethnic Approaches to Community Health (REACH) program during recent hearing with HHS Secretary Sebelius. (May 16, 2013.)